Informing Emerging Models Through Research Eileen Malone, RN, MSN, MS, EDAC, Senior Partner, Mercury Healthcare Consulting, LLC Ann Sloan Devlin, PhD, May Buckley Sadowski ‘19 Professor of Psychology, Connecticut College Tama Duffy Day, FIIDA, FASID, LEED AP BD+C, Global Interior Design Healthcare Practice Leader, Perkins+Will
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Informing Emerging Models Through Research · 2018. 4. 4. · Informing Emerging Models Through Research Eileen Malone, RN, MSN, MS, EDAC, Senior Partner, Mercury Healthcare Consulting,
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Informing Emerging
Models Through
Research
Eileen Malone, RN, MSN, MS, EDAC, Senior Partner,
Mercury Healthcare Consulting, LLC
Ann Sloan Devlin, PhD, May Buckley Sadowski ‘19
Professor of Psychology, Connecticut College
Tama Duffy Day, FIIDA, FASID, LEED AP BD+C, Global Interior Design
Healthcare Practice Leader, Perkins+Will
Agenda
• 2010 Patient Protection and Affordable Care Act Impacts
– Patient harm and reimbursement
– Making care more accessible and affordable
• Addressing Human Needs through Research
• Research Translation thru Design
• Questions and Discussion
National Strategy for Quality Improvement in Health Care
•Triple Aim
Better care
Healthy people/healthy communities
Affordable care
•National Quality Strategy Priorities
Making care safer by reducing harm caused in the delivery of care
Ensuring that each person and family are engaged as partners in their care
Promoting effective communication and coordination of care
Promoting the most effective prevention and treatment practices for the leading causes of mortality, starting with cardiovascular disease
Working with communities to promote the wide use of best practices to enable healthy living
Making quality care more affordable for individuals, families, employers and governments by developing and spreading new health care delivery models
Blueprint to prioritize quality improvement efforts, share lessons and measure collective success
Led by The Agency for Healthcare Research and Quality
Fueling Healthcare Safety Reform: Fix Safety or Suffer Financial Consequences
CMS reimbursement tied to quality
outcomes
Legislation
2005 DRA
2010 ACA
Public reporting of
safety outcomes
National Quality Strategy Long-Term Goals for Making Care Safer: 1. Reduce preventable hospital admissions and readmissions. 2. Reduce the incidence of adverse health care-associated conditions. 3. Reduce harm from inappropriate or unnecessary care.
Patient safety focus
Legislative-driven Healthcare Shift: From Payment for Volume to Quality • 2005 Defense Threat Reduction Act Section 5001(c)
Starting in FY 09, hospitals are no longer paid at the higher rate for the increased cost of care that results when a patient is harmed.
• 2010 Patient Protection and Affordable Care Act
• Patient safety and hospital-acquired conditions are targeted in
two CMS Programs:
– Hospital Value-Based Purchasing Program -
Reimbursement now tied to performance
• FY 13 – 30-day readmission rates and the patient
experience (HCAHPS) 2 HCAHP questions specific to
the environment – hospital cleanliness & quiet
• FY 14 – Mortality measures
• FY 15 – Patient safety indicators
• FY 16-17 Hospital acquired conditions and AHRQ
composite measures of quality
– Partnership for Patient Program – a national patient safety
and quality improvement initiative with10 focus areas
Partnership for Patient Goals
• Hospital Acquired Conditions (HACs): Reduce by 40%
Think Like the Owner Patient Harm + Dissatisfaction = $$ • Ask what problem(s) they are trying to solve and remember that money
drives many (almost all) decisions
• Non-reimbursement of the care associated with the injury
• Better safety scores = better publicity and potential increase in market share
• Cannot admit as many patients, because harmed patients remain in the hospital longer
• Cannot see as many ED and outpatients because they are not efficient – think throughput
• Litigation
You have important solutions to offer as a part of an integrated approach to solving these pernicious problems!
Remember, it is always about the $$$, whether it is the project itself or the costs associated with research.
THINK RETURN-ON-INVESTMENT BEYOND FIRST COSTS
Design Tools to Help Reduce HACs
Patient Goals Design Solutions
Adverse Drug Event (medication errors)
Illumination levels specific to task; Minimize interruptions and distractions; reduce noise; ergonomically designed and task organized work space (USP-NF, 2010)
HAIs (CAUTI, CLABSI, VAP, SSI)
Facilitate hand sanitation; easy to clean surfaces, fixtures, equipment and accessories; filter air contaminates – HEPA, UVGI
Falls and immobility related injuries
Clearances between the bed, chair and equipment; barrier-free access to the bathroom; flooring that is stable, firm, slip-resistant; with minimum joints, low reflectance value and low-contrast flooring patterns; furniture that is sturdy, stable and of a design and seat height appropriate to the patient using it.
Venous Thromboembolism & Pressure Ulcers
NEED RESEARCH! What about the role of ceiling mounted lifts as a component of a comprehensive patient handling and movement program?
Readmissions NEED RESEARCH! Does the family zone result in more family member engagement in discharge planning and fewer readmissions?
The Center for Health Design’s Knowledge Repository
With support from: • The American Institute of
Architects Academy of Architecture for Health
• The Academy of Architecture for Health Foundation
• The American Society for Healthcare Engineering
• The Facility Guidelines Institute • Research Design Connections • Nursing Institute for Healthcare
Design
• Decision making tool
• 2,600 + article references
• Acute, Residential, Ambulatory care
• 100 Key point summaries and growing – condensed summaries written in lay language
The Patient-Centered Medical Home (PCMH) model is an approach to providing comprehensive primary care for children, adolescents, and adults. The PCMH is a health care setting that facilitates partnerships between patients and their personal physicians, and when appropriate, the patient's family. American Academy of Family Practice
Regard™ line for Nurture® by Steelcase was introduced at the 2012 Healthcare Design Conference and won a gold Nightingale award for guest seating.
Safety By regulation (good)
By association (better)
To Address Challenges of Research in Healthcare Settings
-use a variety of approaches:
(multi-method)
-start with simulation
-consider satisficing
– Concept from Nobel laureate Herbert Simon
• “The best is the enemy of the good”
References Almquist, J. R., Kelly, C., Bromberg, J., Bryant, S. C., Christianson, T. J. H., & Montori, V. M. (2009). Consultation room design and the clinical encounter: The space and interaction randomized trial. Health Environments Research & Design Journal, 3(1), 41-78.
Cooke, M., Chaboyer, W., & Hiratos, M. A. (2005). Music and its effect on anxiety in short waiting periods: A critical appraisal. Journal of Clinical Nursing, 14, 145-155. doi:10.1111/j.1365-2702.2004.01033.x
Dickson, F. (2010). Devola Funk’s health care reminder: “You feel healthier when you’re dressed.” http://blog.centerforinnovation.mayo.edu/2010/11/23/ devola-funk’s-health-care-reminder-”you-feel-healthier-when-you’re dressed-”/
http://www.hermanmiller.com/discover/improve-care-save-money-can- standards-do-both/ Karro, J., Dent, A. W., & Farish, S. (2003). Patient perceptions of privacy infringements in an emergency department. Emergency Medicine Australasia, 17(2), 117-123. doi:10.1111/j.1742-6723.2005.00702.x
Lee, K.-C., Chao, Y.-H., Yiin, J.-J., Chiang, P.-Y., & Chao, Y.-F. (2011). Effectiveness of different music-playing devices for reducing preoperative anxiety: A clinical control study. International Journal of Nursing Studies, 48, 1180-1187. doi: 10.1016/j.ijnurstu.2011.04.001
Rouf, E., Chumley, H. S., & Dobbie., A. E. (2008). Electronic health records in outpatient clinics. BMC Medical Education, 8(13), 1-7. doi:10.1186/1472-6920-8-13
Routhieaux, R. L., & Tansik, D. A. (1997). The benefits of music in hospital waiting rooms. The Health Care Supervisor, 16, 31–40.
Shachak, A., & Reis, S. (2009). The impact of electronic medical records on patient- doctor communication during consultation: A narrative literature review. Journal of Evaluation in Clinical Practice, 15, 641-649. doi:10.1111/j. 1365-2753.2008.01065.x
Simon, H. A. (1970). Style in design. In J. Archea & C. Eastman (Eds.), EDRA 2: Proceedings of the 2nd Environmental Design Research Association Conference (pp. 1-10). Stroudsburg, PA: Dowden, Hutchinson, and Ross.
Ulrich, R. S. (1984). View through a window may influence recovery from surgery. Science, 224, 420-421. doi:10.1126/science.6143402
Watkins, N. W., Kennedy, M. M., Ducharme, M. M., & Padula, C. C. (2011). Same- handed and mirrored unit configurations: Is there a difference in patient and nurse outcomes? Journal of Nursing Administration, 41, 273-279. doi: 10.1097/NNA.0b013e31821c47b4